Obamacare in Oregon: Frontier Federalism for Participatory Democracy

I love the Über-P.C. television showPortlandia, or should I call it hyper-P.C.?

A four-way stop is either a death trap or an opportunity to get to know your neighbors. A student I know who spent time in Oregon suggests the skit at the four-way stop where no one moves because there is a competition of niceness — “no, you go” — is realistic, which means it differs from the ones I experienced growing up, when we drove out to various farms to visit relatives in Weed Patch, Arvin, and Lamont, California. In the country, next to the crops, I grew up being cautioned that there were no such things as courteous exchanges, only collisions.

So, now we have another indication of this — and more of a glimpse at Obama’s notion of participatory democracy or federalism for progressive purpose — in Oregon’s experiments with Obamacare at the “pioneer’s end of the road,” as Kirk Johnson tells us in the Timesover the weekend.

Under former ER doctor Governor John Kitzhaber, Oregon is implementing Obamacare by creating 15 advisory panels. These panes constitute participatory democracy or a real avenue of reform for participatory democracy at the local level. This is small “d” progressivism in practice.

Yet, Johnson calls it the federal government’s and Oregon’s almost $2 billion “wager” that Medicaid can be reformed with “hyper-local focus.” But why is it “hyper”? What the state supposedly has to fear from this effort at frontier participatory democracy is that if “Oregon fails on either front [i.e., improved outcomes and reduced spending growth], the consequences are grave, potentially tens of millions of dollars in penalties a year, bleeding a state budget still wounded from recession.”

This is federalism for progressive purpose. For the sake of alliteration, let’s call it “frontier federalism,” with advisory councils practicing public-health principles such as helping pregnant women stop smoking. And their “invasive” tactics are shocking, such as giving gift cards (presumably not for a wine-and-blue-cheese basket).

Is this new? Don’t think so. I remember a Dutch friend with child (less than 6 months) bitterly complaining about how everyone was too happy about her news, all while her maternalistic state’s munificence beat gift cards by a mile (you got a nanny and a cleaner so you could sleep and your male partner wouldn’t feel too put out). Since she was not even showing, I couldn’t figure this out — how did they know? Then she explained that the minute she was sure, she had registered for a safe delivery at the local agency — and they would practically paint her nursery, if she couldn’t and her partner didn’t feel up to it, given the “life change.”

Now, in the Netherlands, this is independent of income, or at least back in the late 1980s it certainly was. In the United States, it’s entirely dependent on income — all our help to the poor — whether it was with charities and religious institutions before the 20th century, or on the state and federal levels in the 20th and 21st centuries. Our charity has always been invasive.

Johnson cites concerns about invasiveness: The next wonky worry is what will happen when the federal government pulls the rug out if Oregon’s Obamacare pioneers cannot achieve their “measurable goals within the five-year timeline of the federal agreement.”

All these what-ifs are exhausting, but we know the story. If nothing happens, the executive branch will do for Oregon what it always does in federalism, let alone frontier federalism for a progressive purpose: exception, exemption, extension. Five-year plans are not exactly Stalinist in the United States — and besides, it will be another president’s headache anyway.